1. Hepatitis C

2. What is Hepatitis?
Hepatitis: A general term meaning inflammation of the liver
Hepatitis can be caused by:
Alcohol
Drugs
Chemicals
Toxins
Autoimmunity (your immune system attacks your own body)
Viral infections

3. Overview of the Liver Largest internal organ
Has over 500 vital functions
Involved in many digestive, vascular, and metabolic activities

4. What does the Liver do?
Functions as the body's chemical processing plant
Stores iron, vitamins, minerals, sugars
Produces bile, cholesterol, lymph
Regulates blood clotting, glucose, hormone levels
Cleans the blood of bacteria and toxins
Processes food, alcohol, drugs
Converts food and drink into forms the body can use
Oxidizes triglycerides to produce energy

5. What does the Liver do?
Basically, the liver processes everything we eat, drink, swallow, breathe, and/or absorb!

6. Hepatitis C Caused by the hepatitis C virus (HCV)
Incubation period 6-7 weeks
Often no signs or symptoms
About 4.1 million in U.S have been infected
Estimated 115,000 infected in WA
About 55-85% of adults have chronic infection

7. HCV Transmission
Primarily transmitted via direct blood-to-blood contact
highly infectious
Stable in environment for at least 16 hours but no longer than 4 days
Most common transmission through the sharing of drug paraphernalia

8. HCV Transmission cont. Also blood transfusions & products before 1992
Perinatal transmission
Needle stick/healthcare exposure
Other blood risks low/unknown risk
tattooing/piercing
intranasal cocaine use
shared personal items

9. Prevention of HCV Transmission
Avoid blood exposure:
New syringe, cooker, cotton etc. every time for injection
Use universal precautions
Don't share personal items that may contain blood (toothbrush/razor)
Use barriers and lubricants
Cover open cuts and wounds
Ensure instruments used for tattooing, piercing, and accupuncture are new or sterilized

10. HCV Transmission: Sharing Injection Equipment
Studies have found high rates of HCV in IDUs who didn't share syringe, but shared cooker, cotton, water or other paraphernalia
People who inject other things (steroids, vitamins, hormones) may also be at risk
IDUs should use new, sterile equipment every time
clean hands, injection site and surface too
Unknown if bleach kills HCV

11. HCV Transmission: Mother-to-Infant
5-6% risk with pregnancy
post exposure prophylaxis not available
co-infection with HIV risk increases up to 17%
Test infants born to HCV-positive women
consider testing any children born since women became infected
evaluate infected children for chronic disease
Breastfeeding ok unless nipples are cracked and/or bleeding

12. HCV Transmission: Low/Unknown Risks
Intranasal cocaine/meth use
Some studies have found link to HCV transmission by blood getting into nasal membrane from shared snorting items
Crack use
At least one study (Schaefer) found higher rate of HCV in non-injecting crack users who indicated cracked, bleeding or burned lips
Personal items with blood on them
Anything that cuts/breaks the skin or membreane
Razors, clippers, toothbrush

13. Hepatitis C and Your Liver
What does it do to the liver?
Causes inflammation
Becomes sensitive to alcohol
Causes blood sugars to rise
Linked to high cholesterol
Want to avoid
Scarring
Cirrhosis
About 20% of cases
Hepatocarcinoma

14. Chronic Hepatitis C Factors promoting progression
Alcohol intake
Age >40 at the time of infection
HIV or HBV co-infection
Male gender
Vaccinate for HAV/HBV when appropriate!
HCV leads to about 10,000 deaths per year from chronic liver disease

15. Symptoms of Chronic Hepatitis
Fatigue
Depression
Loss of appetite
Nausea/indegestion
Muscle/joint pain
Mood swings
"Brain fog"
Abdominal pain
Fever

16. Symptoms of Late Stage Hepatitis with Cirrhosis
All of the symptoms of Hepatitis C with addition of:
Vomiting
Jaundice
Cognitive dysfunction
Fluid retention
Frequent urination
Lack of concentration
Confusion
Dizziness

17. Co-infection: HCV/HIV
Up to 1/3 of those living with HIV also have HCV
1/10 of those with HCV have HIV
HIV positive persons with IDU risk who have tested negative for anti-HCV may want to have viral test
HCV considered OI in people living with HIV
HIV infection may promote HCV disease progression
Anti-HIV medications may cause hepatitis
Especially in those with viral hepatitis

18. Supporting a Healthy Liver
Drink water
Do not drink alcohol
Get vaccinated against hepatitis A & B
Eat a healthy diet
Exercise
Reduce stress
Minimize contact with other toxins
Check with your health provider before starting new medications

19. Alcohol & the liver Avoid alcohol! Will accelerate liver injury
May kill cells & cause oxidative damage
Decreases effectiveness of interferon

20. Keep Your Liver Healthy!
Eat low-fat, low-cholesterol
< 30% of calories from fat, ~ 65g a day
< 10% of calories from saturated fat
Fat can be malabsorbed
High fat intake can lead to infections
High saturated fat intake can lead to increased heart disease risk

21. Keep Your Liver Healthy!
Eat carbs in moderation
50-55% of calories, ~ 300g a day
Eat whole grains
Check the label for fiber!
Wheat bread, brown rice, whole wheat pasta, whole grain cereals

22. Keep Your Liver Healthy!
Eat protein
15-20% of calories, ~ g a day
less with acute liver failure
Eat enough calories daily
Target ~ 3,000 cal/day
Prevent breaking down body tissues for energy
Try omega-3 fats
Decreases inflammation
Wild tuna, wild salmon, walnuts, flaxseed

23. Keep Your Liver Healthy!
Try Antioxidants
Bright colored fruits and vegetables
Red grapes, pomegranate, melons, apples, broccoli, cabbage, cauliflower, onion, bell peppers
Eat small, frequent meals
Relieves burden of the liver to store extra carbohydrate calories
Maintain a healthy weight
High Body Mass Index (BMI)
Linked to poor recovery
Increases diabetes risk

24. Patient Support Programs
Hepatitis C Case Management Program
Free Assistance with medical resourced in Washington State
Aid in locating places that provide care, treatment, services
Aid in finding financial aid for treatment & testing
Patient assistance programs via Pharmaceutical companies
DSHS
Charity Care

25. Patient Support Programs
Pharmaceutical companies offer assistance programs
Genentech Access Solutions
Ships medications free of charge to those who qualify
based on household income
Pegasys Access to Care
Possible medication free of charge to those who qualify
Many hospitals provide charity assistance programs to uninsured
KVCH
Harborview
Virginia Mason

26. Psychosocial Support Friends and family Support groups Hotlines
Internet
Most providers who treat will ask for psych assessment and refer to counseling

27. Local Support Groups Yakima Wenatchee Seattle
Wellness House 210 S. 11th Ave
Wenatchee
Wellness Place 208 N. Chelan
Seattle
HEP Resource Center 911 Western Ave #302

28. Chronic Hepatitis & Transmission Prevention
Do not donate blood, body organs, other tissue, or semen
Do not share personal items that might have blood on them
razor, toothbrush, clippers
Cover cuts and sores on the skin
Never reuse or share syringes, needlesm cottons, cookers and water
Use barriers for sexual intercourse.
For those with HCV and one long-term partner, should discuss with partner to make decision about condom use

29. Chronic Hepatitis & Transmission Prevention
HCV is not spread by
sneezing, hugging, coughing, sharing eating utensils or drinking glasses, or casual contact
HCV positive persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV status